Continuing healthcare and long-term residential care – who pays?

All nursing care is free.  This is a fundamental of the NHS.  However, not all care is nursing care and a good deal of care is classed as social care.  The social care element is not free and there are circumstances where you would have to pay for the social care you receive (such as the so called ‘hotel costs’ of any residential care).

If you have been the subject of an Order under Section 3 of the Mental Health Act 1983, then you are entitled to free after care under Section 117.

Otherwise, you will receive a health assessment.  If – and this is a big if – your primary need is nursing care, then you will not pay any fees for your care at all.  All your costs and fees will be paid for by the Local Authority, including the social care elements, and the hotel costs of any residential care. This is the case, regardless of what wealth you may have. This is referred to as Continuing Healthcare or CHC for short.

If, on the other hand, nursing care is not the primary need, then yes, you may have to pay a contribution to your care (the nursing element, if there is one, will still be free and paid for). Your income and savings, including the value of your home, will be assessed and you will contribute to the cost of your care arrangements, down to capital savings of £23,250.  There is more on this in our paying for care guide.

How do I apply for CHC?

Let’s be honest; it is not in the interests of the Local Authority for anyone to be awarded CHC.  Local Authorities have budgets and their resources are constantly under pressure.  The process is a difficult one. There is an initial assessment of your health and a checklist is completed.  The second stage is a far more detailed assessment when your health needs will be judged against set criteria using a standardised toolkit.and marks awarded for each one.

To receive CHC you would need to beat the threshold mark and minimum criteria.  However, to do so you will need to demonstrate that your needs present a high risk or are complex to manage. The meeting will involve Social Services and a nurse from the NHS CCG (Clinical Commissioning Group).  The meeting will also involve you and/or your representative. It is vital that you are represented and you should certainly make sure that you are.  We can help with this.

If the outcome is against you, then we can advise on whether an appeal would be worthwhile. A refusal of CHC may not be the end of the road.  It has even been possible to recover care costs on a retrospective award of CHC after someone has died, for the benefit of their estate.

Any award of CHC is subject to review and could be withdrawn.  Again, you should be represented at any review.

Safeguarding?

If an individual’s personal or financial welfare is at risk, then there may well be a safeguarding meeting called by the Local Authority to consider what protective steps, if any, should be taken. All the stakeholders will be present including the Local Authority social workers, police (if a crime is being alleged), and any relevant care agencies and people closely associated with the individual at risk. The safeguarding meeting will decide what steps should be taken in the best interests of the individual.

Multi-disciplinary meetings

Here an individual is not necessarily at risk, but the individual and stakeholders including perhaps the Local Authority Social Services, other care agencies, and family members will come together to decide on a care plan which will be in the individual’s best interests and a review structure. The difficulty is that there may be different views as what would be in best interests. This can sometimes be contentious.

Are there any steps I should take now which might help in the future?

Yes.  Everyone should create Lasting Powers of Attorney for both Finance and for Welfare.  This will ensure that someone of your choosing, who you trust and who will best know your preferences, will be able to have a voice with the authorities if you are not in a position, perhaps because of illness or disability, to speak for yourself. There is more information on this website about Powers of Attorney, and we are always glad to help.

Everyone should make a Will.  There is more information about Wills on this website, and we are always glad to answer your queries.

For a married couple or civil partners their Will might include a property trust which can protect property ownership against long-term care charges. The trust would typically place the half share interests in the property owned by each of the couple into a trust for the benefit of the other partner. There is  more information about this in our planning for care guide, found on this website.

In short, it’s always best to seek legal advice and we are here to help you.

For more information please consult our Continuing healthcare and long-term residential care – who pays? Experts:

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